Communications with the doctor: considerations for the use of text messages and social networks
For starters, physicians should be aware that in 2011, the American Medical Association issued guidelines in its Code of Ethics for Physicians Using Social Media:
• Physicians must safeguard patient privacy and confidentiality online and through text messages, and must refrain from posting identifiable patient information;
• Clinicians should realize that privacy settings are not absolute and that once on the Internet, content is likely to remain there permanently.
• If they interact with patients on the Internet, doctors must maintain the same professional and ethical limits as in any other context.
• Physicians are strongly encouraged to separate personal and professional content online.
• Physicians must uphold the profession and take action if colleagues post unprofessional or unethical content.
• Physicians must recognize that online actions and posted content may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers, and may undermine public trust in the medical profession.
Interactions with other doctors
Connecting with other doctors through social media is a great way to share information and improve the profession. However, most of the time texting and using social media to work with other doctors is not appropriate.
Physician-to-physician messages for the purpose of treating an individual must be timely and properly documented in the patient’s medical record. Right now, that’s terribly difficult to do successfully and consistently.
There are at least a few popular social media platforms that are exclusive to doctors only. Some of them say they allow anonymous posts and interactions. However, clinicians must realize that almost nothing on the Internet is anonymous. Physicians must ensure that they adhere to the ethics and obligations of medical practice when posting anything on any site, whether or not their names are available. HIPAA doesn’t just subsidize because a doctor’s name isn’t directly linked to a post. It also does not fund because a patient’s name is not mentioned in a publication.
It is good practice for a clinician to back away from the post or text before sending it, to consider what purpose it will serve and whether it preserves the confidentiality and ethical obligations necessary for the situation.
Additionally, physicians’ interactions with other physicians on pure social networks, especially with their superiors at work, can blur the lines between professional and personal life. Supervising physicians (employers, assistants, professors, etc.) should not attempt to connect with their subordinates through social media and subordinate physicians should think twice before requesting to connect with supervising physicians.
Interactions with patients
First, prior to any interaction with a patient via social media, text messaging, video conferencing, or similar transmission, physicians must comply with any and all applicable telemedicine statutes in the states where they practice. Telemedicine laws are constantly evolving to keep up with changes in the area of communications, and physicians are well-informed to familiarize themselves with the laws.
The AMA Code of Medical Ethics contains an opinion on the use of email to communicate with a patient. Perhaps most importantly, the Code states that email correspondence must complement a doctor’s personal encounters with a patient. In addition, a doctor is held to the same professional and ethical standards by email as they are in person. Medical advice or patient-specific information should not be transmitted over an insecure connection without the prior authorization of the patient.
Although the AMA has not published guidance regarding text message communications with patients, physicians are encouraged to consider using the same guidelines. For example, text messages containing patient-specific data should not be sent over an unsecured or public connection. Copies of the text message should be kept in the patient’s file to ensure continuity of care. And doctors need to realize that they are held to the same standard of care over texting as they are in their office encounters. A single text message delivered without a complete image could expose the physician to the same liability as an inaccurate in-office assessment. Adequacy of care cannot be sacrificed for ease of communication.
Messages sent to patients via social media are even more problematic. Patient privacy laws generally preclude providing patient-specific information in this way. Furthermore, even if patient-specific information is not transmitted via social media, a physician’s failure to maintain proper professional boundaries with their patients can tarnish the profession’s reputation and subject the physician to disciplinary action.